| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Date/Time of Birth | 12/23/2009 |
| Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT |
| Patient Phone | (203)555-1212 |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Date/Time of Birth | 12/23/2009 |
| Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT |
| Patient Phone | (203)555-1212 |
The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EMR in response to the query for patient (Juana Mariana Gonzales). The provider reviews the immunization history from the registry and compares to the immunization history in the EMR. The provider reconciles the information from these sources, importing information known only to the registry, retaining information that is more accurately reflected in the local EMR: The physician accesses the record for Juana Mariana Gonzales and:
• Reconciles the EHR vaccine history with the history retrieved from the registry:
o Accepts new vaccines from the registry data
o If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)
o Retains the local history for influenza and polio vaccines that are not included in the registry report.
|
No Comments |
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. |
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales) |
Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them. The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient’s local immunization history and include the time of the update and the source of the new information. Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).
|
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juana | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Acosta | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 200912231105 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 4345 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551212 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | .25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120404 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 10 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 11 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 12 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100323 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100323 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 26 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 27 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 28 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 29 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20110221 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20110221 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 70 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 88 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 89 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20111123 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20111123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20120523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20120523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | N | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 101 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30982-3 | |
| OBX.3.2 | Text | Reason code | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20101023 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20101023 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 102 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 103 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 104 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 105 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20121122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20121122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160131 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juana | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Acosta | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 200912231105 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 4345 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551212 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | .25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120404 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 10 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 11 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 12 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100323 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100323 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 26 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 27 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 28 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 29 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20110221 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20110221 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 70 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 88 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 89 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20111123 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20111123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20120523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20120523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | N | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 101 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30982-3 | |
| OBX.3.2 | Text | Reason code | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20101023 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20101023 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 102 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 103 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 104 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 105 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20121122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20121122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160131 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry) |
If the EMR already recognizes the dose as invalid, then this step may be skipped. |
MMRV status indicates that the first MMRV dose is valid. |
MMRV status for the first MMRV dose administered on 10/23/2010 is set to invalid. |
dose validity is an important aspect of: Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.
|
Vendor is able to record that the vaccination dose is invalid with a reason that it was given too early |
No Note |
The physician accesses the record for Juana Mariana Gonzales and: • Displays the registry forecast which includes the need for a second, valid MMRV vaccine and also the need for influenza and polio vaccines (since the registry has no information about them) |
No Comments |
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. |
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales) |
View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS). The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast. |
1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 2. Verify that All forecast vaccines and dates returned by the registry are displayed to the user. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juana | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Acosta | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 200912231105 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 4345 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551212 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | .25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120404 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 10 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 11 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 12 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100323 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100323 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC12 | |
| OBX.5.2 | Text | fever of >40.5C (105F) within 48 hours of dose | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 26 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 27 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 28 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 29 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20110221 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20110221 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 70 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 88 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 89 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20111123 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20111123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300004211111025 | |
| OBX.5.2 | Text | Hepatitis A VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20120523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20120523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300004211111025 | |
| OBX.5.2 | Text | Hepatitis A VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 94 | |
| OBX.5.2 | Text | MMRV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | N | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 101 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30982-3 | |
| OBX.3.2 | Text | Reason code | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 264499004 | |
| OBX.5.2 | Text | Early | |
| OBX.5.3 | Name of Coding System | SCT | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20101023 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20101023 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300013411100521 | |
| OBX.5.2 | Text | Measles/Mumps/Rubella/Varicella VIS | |
| OBX.5.3 | Name of Coding System | ||
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 102 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 94 | |
| OBX.5.2 | Text | MMRV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 103 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 104 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 105 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20121122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20121122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300013411100521 | |
| OBX.5.2 | Text | Measles/Mumps/Rubella/Varicella VIS | |
| OBX.5.3 | Name of Coding System | ||
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160131 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 03 | |
| OBX.5.2 | Text | MMR | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 21 | |
| OBX.5.2 | Text | Varicella | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | MYIIS | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | MyStateIIS | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | MYEHR | |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | Myclinic | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20091130020020-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | RSP | |
| MSH.9.2 | Trigger Event | K11 | |
| MSH.9.3 | Message Structure | RSP_K11 | |
| MSH.10 | Message Control ID | 7731029 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | NE | |
| MSH.16 | Application Acknowledgment Type | NE | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z42 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | A_Clinic | |
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | X68 | |
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | AN | |
| MSH.22.10 | Organization Identifier | A_Clinic1234 | |
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | |
| MSA.2 | Message Control ID | 793543 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK.1 | Query Tag | 37374859 | |
| QAK.2 | Query Response Status | OK | |
| QAK.3 | Message Query Name | ||
| QAK.3.1 | Identifier | Z44 | |
| QAK.3.2 | Text | Request Evaluated History and Forecast | |
| QAK.3.3 | Name of Coding System | CDCPHINVS | |
| QAK.3.5 | Alternate Text | ||
| QAK.3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD.1 | Message Query Name | ||
| QPD.1.1 | Identifier | Z44 | |
| QPD.1.2 | Text | Request Evaluated History and Forecast | |
| QPD.1.3 | Name of Coding System | CDCPHINVS | |
| QPD.1.5 | Alternate Text | ||
| QPD.1.6 | Name of Alternate Coding System | ||
| QPD.2 | Query Tag | 37374859 | |
| QPD.3 | PatientList | ||
| QPD.3.1 | ID Number | ||
| QPD.3.3 | Check Digit Scheme | ||
| QPD.3.4 | Assigning Authority | ||
| QPD.3.4.1 | Namespace ID | ||
| QPD.3.4.2 | Universal ID | ||
| QPD.3.4.3 | Universal ID Type | ||
| QPD.3.5 | Identifier Type Code | ||
| QPD.4 | PatientName | ||
| QPD.4.1 | Family Name | ||
| QPD.4.1.1 | Surname | Gonzales | |
| QPD.4.1.2 | Own Surname Prefix | ||
| QPD.4.1.3 | Own Surname | ||
| QPD.4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.4.1.5 | Surname From Partner/Spouse | ||
| QPD.4.2 | Given Name | Juana | |
| QPD.4.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| QPD.4.7 | Name Type Code | L | |
| QPD.5 | PatientMotherMaidenName | ||
| QPD.5.1 | Family Name | ||
| QPD.5.1.1 | Surname | Acosta | |
| QPD.5.1.2 | Own Surname Prefix | ||
| QPD.5.1.3 | Own Surname | ||
| QPD.5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD.5.1.5 | Surname From Partner/Spouse | ||
| QPD.5.7 | Name Type Code | M | |
| QPD.6 | PatientDateOfBirth | ||
| QPD.6.1 | Time | 200912231105 | |
| QPD.7 | Patient Sex | F | |
| QPD.8 | Patient Address | ||
| QPD.8.1 | Street Address | ||
| QPD.8.1.1 | Street or Mailing Address | 4345 Standish Way | |
| QPD.8.1.2 | Street Name | ||
| QPD.8.1.3 | Dwelling Number | ||
| QPD.8.2 | Other Designation | ||
| QPD.8.3 | City | Stamford | |
| QPD.8.4 | State or Province | CT | |
| QPD.8.5 | Zip or Postal Code | ||
| QPD.8.6 | Country | ||
| QPD.8.7 | Address Type | L | |
| QPD.9 | Phone | ||
| QPD.9.2 | Telecommunication Use Code | PRN | |
| QPD.9.3 | Telecommunication Equipment Type | PH | |
| QPD.9.4 | Email Address | ||
| QPD.9.6 | Area/City Code | 203 | |
| QPD.9.7 | Local Number | 5551212 | |
| QPD.10 | Multiple birth indicator | ||
| QPD.11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | |
| PID.5.7 | Name Type Code | L | |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | |
| PID.8 | Administrative Sex | F | |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | |
| PID.11.5 | Zip or Postal Code | 06903 | |
| PID.11.6 | Country | USA | |
| PID.11.7 | Address Type | L | |
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | ||
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | ||
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197023 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | STIIS | |
| ORC.17.2 | Text | StateIIS | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | .25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120404 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.25 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.5 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | new immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091031 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 998 | |
| RXA.5.2 | Text | no vaccine admin | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 4 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 5 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 6 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 7 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 8 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 9 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 31 | |
| OBX.5.2 | Text | Hep B Peds NOS | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 10 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 11 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 12 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 13 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 14 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 15 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 16 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 17 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 18 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 19 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 20 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100323 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100323 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC12 | |
| OBX.5.2 | Text | fever of >40.5C (105F) within 48 hours of dose | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 22 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 23 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 24 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 25 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 26 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 107 | |
| OBX.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 27 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 28 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 29 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 5 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20070517 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20110221 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20110221 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300003511070517 | |
| OBX.5.2 | Text | Diphtheria/Tetanus/Pertussis (DTaP) VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 30 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 31 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 32 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 33 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 34 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 35 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 36 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 37 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 38 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 39 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 40 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 41 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 42 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 17 | |
| OBX.5.2 | Text | Hib, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 43 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 44 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 45 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 46 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 47 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 48 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 49 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 50 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | poliovirus vaccine, inactivated | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 51 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 52 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 53 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 54 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 55 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 56 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 57 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 58 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 59 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 60 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 61 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 62 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 63 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 64 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 65 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 66 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 109 | |
| OBX.5.2 | Text | pneumococcal, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 67 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 68 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 69 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 70 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 71 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 72 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 73 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 74 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 122 | |
| OBX.5.2 | Text | rotavirus, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 75 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 76 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 3 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 78 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 79 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 80 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 81 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 82 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 83 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 84 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 85 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 86 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 87 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 88 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 89 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 90 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 91 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 92 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 93 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20111123 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20111123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300004211111025 | |
| OBX.5.2 | Text | Hepatitis A VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 94 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 85 | |
| OBX.5.2 | Text | Hep A, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 95 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 96 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 97 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20111025 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20120523 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20120523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300004211111025 | |
| OBX.5.2 | Text | Hepatitis A VIS | |
| OBX.5.3 | Name of Coding System | cdcgs1vis | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 98 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 94 | |
| OBX.5.2 | Text | MMRV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 99 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | N | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 101 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30982-3 | |
| OBX.3.2 | Text | Reason code | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 264499004 | |
| OBX.5.2 | Text | Early | |
| OBX.5.3 | Name of Coding System | SCT | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20101023 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20101023 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300013411100521 | |
| OBX.5.2 | Text | Measles/Mumps/Rubella/Varicella VIS | |
| OBX.5.3 | Name of Coding System | ||
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 102 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 94 | |
| OBX.5.2 | Text | MMRV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 103 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 104 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 1 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 105 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 100 | |
| OBX.2 | Value Type | ID | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59781-5 | |
| OBX.3.2 | Text | Dose validity | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 3 | |
| OBX.5 | Observation Value | Y | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20121122 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS presented | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | 20121122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 69764-9 | |
| OBX.3.2 | Text | Document type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 253088698300013411100521 | |
| OBX.5.2 | Text | Measles/Mumps/Rubella/Varicella VIS | |
| OBX.5.3 | Name of Coding System | ||
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F< | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20100522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110522 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20110523 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 10 | |
| OBX.5.2 | Text | IPV | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 106 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 88 | |
| OBX.5.2 | Text | influenza, unspecified formulation | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 107 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20150901 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20160131 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 109 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 4 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 110 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 2 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 03 | |
| OBX.5.2 | Text | MMR | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 111 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 113 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 114 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30956-7 | |
| OBX.3.2 | Text | vaccine type | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | 21 | |
| OBX.5.2 | Text | Varicella | |
| OBX.5.3 | Name of Coding System | CVX | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 115 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59779-9 | |
| OBX.3.2 | Text | Immunization Schedule used | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC16 | |
| OBX.5.2 | Text | ACIP | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30981-5 | |
| OBX.3.2 | Text | Earliest date to give | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 112 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30980-7 | |
| OBX.3.2 | Text | Date vaccination due | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20131122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59777-3 | |
| OBX.3.2 | Text | Latest date next dose may be given | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151122 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 108 | |
| OBX.2 | Value Type | DT | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59778-1 | |
| OBX.3.2 | Text | Date dose is overdue | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 20151123 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 117 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 30973-2 | |
| OBX.3.2 | Text | dose number in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20141216 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 77 | |
| OBX.2 | Value Type | NM | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 59782-3 | |
| OBX.3.2 | Text | number of doses in series | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | 2 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | NA | |
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | HL70353 | |
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time |
No Description |
No Comments |
A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and the response is available in the EMR for reconciliation and import. |
Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales) |
Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry. |
1. The user imports returned vaccinations as follows:
a. Vaccinations NOT imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 1/15/2010
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
VERIFY that the dose validity is marked as invalid
b. Vaccinations Imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08) administered 10/30/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2010,
Including adverse reaction 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2011
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 2/21/2011
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2010
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 2/21/2011
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/25/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/27/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/2/2011
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 11/4/2012
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2011
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2012
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
|
No Note |
Once the vaccine history is reconciled in the EMR, the vaccine forecast is updated. |
No Comments |
EMR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Gonzales'). |
An updated vaccine forecast based upon the reconciled vaccine history is available to the user. |
View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service. |
Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history: 1. Verify that the EMR does not include in reconciled vaccine forecast:
IPV due on 5/22/2010
2. Verify that the EMR includes in reconciled vaccine forecast:
IPV due on 11/22/2013
MMR due on 5/22/2011
Varicella due on 5/22/2011
influenza, unspecified formulation due on 10/21/2015
|
No Note |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
|
The physician accesses the record for Juana Mariana Gonzales and: • Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine |
No Comments |
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. |
IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures). |
Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record. |
EMR Records the following order information and Alert: Entered BY: Sandra Molina Ordering Provider: Frank Smith |
No Note |
|
The mother is concerned about administering the IPV due to the prior adverse reaction, and refuses to have the child immunized for IPV. The provider documents mother’s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent. |
No Comments |
Prior Immunization History loaded and reconciled from the Immunization Registry. Order is attempted for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures. |
Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is permanent. |
Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.). The system also stores that information in a structured way so it can be reported and analyzed as needed. |
EMR documents the non-administration of the IPV due to the parental refulsal: |
No Note |
|
The nurse administers the the MMRV vaccine
|
No Comments |
|
Order is placed for MMRV vaccine. |
|
The MMRV vaccination is recorded in the EMR. |
|
Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered. The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size. |
EMR Records the following vaccine administration information: Entered BY: Sandra Molina [Y] Ordering Provider: Frank Smith [Y] |
No Note |
| Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS. |
| The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS. |
| The vaccines for the visit have been administered. |
| No PostCondition |
| Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
| No evaluation criteria |
| No Note |
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS. |
The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS. |
The vaccines for the visit have been administered. |
The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission. |
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.01 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | Test Case Fixed |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Acosta | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | Test Case Fixed |
| PID.8 | Administrative Sex | F | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2131-1 | Test Case Fixed |
| PID.10.2 | Text | Other Race | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 325 Shorline Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06901 | |
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | BDL | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551212 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Gonzales | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Joanna | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Merida | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRP | Test Case Fixed |
| NK1.3.2 | Text | Grandparent | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | Test Case Fixed |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06901 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | Test Case Fixed |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551212 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Ricci | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Gina | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sirtis | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lisa | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Immunization | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK1 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101001 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK24 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120831 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2341 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2433 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110904 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS3255 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101201 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS249 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110301 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20140831 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D643QS8243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140901 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M54K9245 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100324 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M55K3342 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101030 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M75K4566 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100523 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M53K5534 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV2431 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101004 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4344 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D335PV9644 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150519 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P243V3281 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P343V8321 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100330 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V2164 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100830 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V58532 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110418 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV533 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV932 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100510 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9334IN9333 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120522 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 03 | |
| RXA.9.2 | Text | Historical information - from parents written record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Ricci | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Gina | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3423 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140701 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune, LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | Test Case Fixed |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.2 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3521 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150815 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | Test Case Fixed |
| RXA.17.2 | Text | MedImmune,LLC | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121104 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9553IN2243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120430 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120124 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT48 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120911 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W27V7491 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3452 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130413 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | Test Case Fixed |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ProQuad | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.5 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3687 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150715 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | Test Case Fixed |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | Test Case Fixed |
| RXR.1.2 | Text | Nasal | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Nasal | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | Test Case Fixed |
| RXR.1.2 | Text | Subcutaneous | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Subcutaneous | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | Test Case Fixed |
| RXR.2.2 | Text | Left Deltoid | Test Case Fixed |
| RXR.2.3 | Name of Coding System | HL70163 | Test Case Fixed |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC12 | |
| OBX.5.2 | Text | fever of >40.5C (105F) within 48 hours of dose | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | Test Case Fixed |
| OBX.3.2 | Text | VIS Publication Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20140819 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | Test Case Fixed |
| OBX.3.2 | Text | VIS Presentation Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | Test Case Fixed |
| OBX.3.2 | Text | vaccine fund pgm elig cat | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | Test Case Fixed |
| OBX.3.2 | Text | VIS Publication Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | Test Case Fixed |
| OBX.3.2 | Text | VIS Presentation Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | Test Case Fixed |
| OBX.3.2 | Text | vaccine fund pgm elig cat | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.01 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | Test Case Fixed |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Acosta | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | Test Case Fixed |
| PID.8 | Administrative Sex | F | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2131-1 | Test Case Fixed |
| PID.10.2 | Text | Other Race | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 325 Shorline Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06901 | |
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | BDL | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551212 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Gonzales | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Joanna | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Merida | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRP | Test Case Fixed |
| NK1.3.2 | Text | Grandparent | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | Test Case Fixed |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06901 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | Test Case Fixed |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551212 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Ricci | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Gina | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sirtis | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lisa | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Immunization | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK1 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101001 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK24 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120831 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2341 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2433 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110904 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS3255 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101201 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS249 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110301 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20140831 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D643QS8243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140901 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M54K9245 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100324 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M55K3342 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101030 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M75K4566 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100523 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M53K5534 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV2431 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101004 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4344 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D335PV9644 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150519 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P243V3281 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P343V8321 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100330 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V2164 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100830 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V58532 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110418 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV533 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV932 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100510 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9334IN9333 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120522 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 03 | |
| RXA.9.2 | Text | Historical information - from parents written record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Ricci | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Gina | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3423 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140701 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune, LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | Test Case Fixed |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.2 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3521 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150815 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | Test Case Fixed |
| RXA.17.2 | Text | MedImmune,LLC | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121104 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9553IN2243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120430 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120124 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT48 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120911 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W27V7491 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3452 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130413 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | Test Case Fixed |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ProQuad | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.5 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3687 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150715 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | Test Case Fixed |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | Test Case Fixed |
| RXR.1.2 | Text | Nasal | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Nasal | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | Test Case Fixed |
| RXR.1.2 | Text | Subcutaneous | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Subcutaneous | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | Test Case Fixed |
| RXR.2.2 | Text | Left Deltoid | Test Case Fixed |
| RXR.2.3 | Name of Coding System | HL70163 | Test Case Fixed |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | VXC12 | |
| OBX.5.2 | Text | fever of >40.5C (105F) within 48 hours of dose | |
| OBX.5.3 | Name of Coding System | CDCPHINVS | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | Test Case Fixed |
| OBX.3.2 | Text | VIS Publication Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20140819 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | Test Case Fixed |
| OBX.3.2 | Text | VIS Presentation Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | Test Case Fixed |
| OBX.3.2 | Text | vaccine fund pgm elig cat | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | Test Case Fixed |
| OBX.3.2 | Text | VIS Publication Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | Test Case Fixed |
| OBX.3.2 | Text | VIS Presentation Date | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | Test Case Fixed |
| OBX.3.2 | Text | vaccine fund pgm elig cat | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Identifier | V01 | |
| OBX.5.2 | Text | Not VFC elig | |
| OBX.5.3 | Name of Coding System | HL70064 | |
| OBX.5.5 | Alternate Text | ||
| OBX.5.6 | Name of Alternate Coding System | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Mother's Maiden Name | Maria Acosta |
| ID Number | 123456 987633 |
| Date/Time of Birth | 12/23/2009 |
| Administrative Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT 06903 USA |
| Patient Address 1 | 325 Shorline Drive Stamford CT 06901 |
| Local Number | (203)555-1212 |
| Race | Other Race |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Joanna Merida Gonzales |
| Relationship | Grandparent |
| Address | 4345 Standish Way Stamford CT 06901 |
| Phone Number | (203)555-1212 |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 11/23/2009 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Lisa Sirtis |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, unspecified formulation |
| Date/Time Start of Administration | 01/15/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Immunization |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6352FK1 |
| Substance Expiration Date | 10/01/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 10/30/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6352FK24 |
| Substance Expiration Date | 08/31/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2341 |
| Substance Expiration Date | 11/30/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2433 |
| Substance Expiration Date | 09/04/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS3255 |
| Substance Expiration Date | 12/01/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Reaction | fever of >40.5C (105F) within 48 hours of dose |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS249 |
| Substance Expiration Date | 03/01/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 08/31/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D643QS8243 |
| Substance Expiration Date | 09/01/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M54K9245 |
| Substance Expiration Date | 03/24/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M55K3342 |
| Substance Expiration Date | 10/30/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M75K4566 |
| Substance Expiration Date | 05/23/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M53K5534 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV2431 |
| Substance Expiration Date | 10/04/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV4344 |
| Substance Expiration Date | 03/23/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D335PV9644 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 05/19/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/21/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P243V3281 |
| Substance Expiration Date | 01/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P343V8321 |
| Substance Expiration Date | 03/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V2164 |
| Substance Expiration Date | 08/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V58532 |
| Substance Expiration Date | 04/18/2011 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV533 |
| Substance Expiration Date | 02/15/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV932 |
| Substance Expiration Date | 05/10/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 09/25/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/27/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/02/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9334IN9333 |
| Substance Expiration Date | 05/22/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/15/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from parents written record |
| Administering Provider | Gina Ricci |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 07/01/2014 |
| Substance Manufacturer Name | MedImmune, LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Gina Ricci |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.2 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 8L4B3521 |
| Substance Expiration Date | 08/15/2015 |
| Substance Manufacturer Name | MedImmune,LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 08/19/2014 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 11/04/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9553IN2243 |
| Substance Expiration Date | 04/30/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 11/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT33 |
| Substance Expiration Date | 01/24/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 05/23/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT48 |
| Substance Expiration Date | 09/11/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 10/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | historical |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W27V7491 |
| Substance Expiration Date | 12/15/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W87V3452 |
| Substance Expiration Date | 04/13/2013 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 7W87V3687 |
| Substance Expiration Date | 07/15/2015 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 05/21/2010 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Mother's Maiden Name | Maria Acosta |
| ID Number | 123456 987633 |
| Date/Time of Birth | 12/23/2009 |
| Administrative Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT 06903 USA |
| Patient Address 1 | 325 Shorline Drive Stamford CT 06901 |
| Local Number | (203)555-1212 |
| Race | Other Race |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Joanna Merida Gonzales |
| Relationship | Grandparent |
| Address | 4345 Standish Way Stamford CT 06901 |
| Phone Number | (203)555-1212 |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 11/23/2009 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Lisa Sirtis |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, unspecified formulation |
| Date/Time Start of Administration | 01/15/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Immunization |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6352FK1 |
| Substance Expiration Date | 10/01/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 10/30/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6352FK24 |
| Substance Expiration Date | 08/31/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2341 |
| Substance Expiration Date | 11/30/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2433 |
| Substance Expiration Date | 09/04/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS3255 |
| Substance Expiration Date | 12/01/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Reaction | fever of >40.5C (105F) within 48 hours of dose |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS249 |
| Substance Expiration Date | 03/01/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 08/31/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D643QS8243 |
| Substance Expiration Date | 09/01/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M54K9245 |
| Substance Expiration Date | 03/24/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M55K3342 |
| Substance Expiration Date | 10/30/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M75K4566 |
| Substance Expiration Date | 05/23/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M53K5534 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV2431 |
| Substance Expiration Date | 10/04/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV4344 |
| Substance Expiration Date | 03/23/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D335PV9644 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 05/19/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/21/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P243V3281 |
| Substance Expiration Date | 01/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P343V8321 |
| Substance Expiration Date | 03/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V2164 |
| Substance Expiration Date | 08/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V58532 |
| Substance Expiration Date | 04/18/2011 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV533 |
| Substance Expiration Date | 02/15/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV932 |
| Substance Expiration Date | 05/10/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 09/25/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/27/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/02/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9334IN9333 |
| Substance Expiration Date | 05/22/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/15/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from parents written record |
| Administering Provider | Gina Ricci |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 07/01/2014 |
| Substance Manufacturer Name | MedImmune, LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Gina Ricci |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.2 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 8L4B3521 |
| Substance Expiration Date | 08/15/2015 |
| Substance Manufacturer Name | MedImmune,LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 08/19/2014 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 11/04/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9553IN2243 |
| Substance Expiration Date | 04/30/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 11/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT33 |
| Substance Expiration Date | 01/24/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 05/23/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT48 |
| Substance Expiration Date | 09/11/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 10/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | historical |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W27V7491 |
| Substance Expiration Date | 12/15/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W87V3452 |
| Substance Expiration Date | 04/13/2013 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 7W87V3687 |
| Substance Expiration Date | 07/15/2015 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 05/21/2010 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Profile Fixed |
| MSH.2 | Encoding Characters | ^~\& | Profile Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | NIST APP | Test Case Fixed |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | NIST Test Iz Reg | Test Case Fixed |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | Test EHR Application | Test Case Fixed |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | X68 | Test Case Fixed |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 200906040000-0500 | System Generated |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | NIST-IZ-ACK-001.01 | Test Case Fixed |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | T | Test Case Fixed |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | Profile Fixed |
| MSH.15 | Accept Acknowledgment Type | NE | Profile Fixed |
| MSH.16 | Application Acknowledgment Type | NE | Profile Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | Profile Fixed |
| MSH.21.2 | Namespace ID | CDCPHINVS | Profile Fixed |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | Test Case Fixed |
| MSA.2 | Message Control ID | NIST-IZ-001.01 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Profile Fixed |
| MSH.2 | Encoding Characters | ^~\& | Profile Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | NIST APP | Test Case Fixed |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | NIST Test Iz Reg | Test Case Fixed |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | Test EHR Application | Test Case Fixed |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | X68 | Test Case Fixed |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 200906040000-0500 | System Generated |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | NIST-IZ-ACK-001.01 | Test Case Fixed |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | T | Test Case Fixed |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | Profile Fixed |
| MSH.15 | Accept Acknowledgment Type | NE | Profile Fixed |
| MSH.16 | Application Acknowledgment Type | NE | Profile Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | Profile Fixed |
| MSH.21.2 | Namespace ID | CDCPHINVS | Profile Fixed |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | Test Case Fixed |
| MSA.2 | Message Control ID | NIST-IZ-001.01 | Test Case Fixed |
Following the vaccine administration, the patient's mother reports that the patient that evening had persistent, inconsolable crying lasting > 3 hours. |
No Comments |
The vaccinations for the visit have been administered. |
The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR. |
Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events. |
Verify that vendor can record the adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose correctly and without omission |
No Note |
The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is reported to the Immunization Registry using a Z22/VXU message. |
No Comments |
An adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR. |
The adverse reaction has been transmitted to the IIS. |
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries. |
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. |
No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.02 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | Test Case Fixed |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Acosta | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | Test Case Fixed |
| PID.8 | Administrative Sex | F | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2131-1 | Test Case Fixed |
| PID.10.2 | Text | Other Race | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 325 Shorline Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06901 | |
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | BDL | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551212 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Gonzales | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Joanna | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Merida | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRP | Test Case Fixed |
| NK1.3.2 | Text | Grandparent | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | Test Case Fixed |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06901 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | Test Case Fixed |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551212 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Ricci | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Gina | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sirtis | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lisa | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Immunization | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK1 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101001 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK24 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120831 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2341 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2433 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110904 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS3255 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101201 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS249 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110301 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20140831 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D643QS8243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140901 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M54K9245 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100324 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M55K3342 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101030 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M75K4566 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100523 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M53K5534 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV2431 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101004 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4344 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D335PV9644 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150519 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P243V3281 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P343V8321 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100330 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V2164 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100830 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V58532 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110418 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV533 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV932 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100510 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9334IN9333 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120522 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 03 | |
| RXA.9.2 | Text | Historical information - from parents written record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Ricci | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Gina | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3423 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140701 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune, LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.2 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3521 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150815 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune,LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121104 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9553IN2243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120430 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120124 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT48 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120911 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W27V7491 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3452 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130413 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | Test Case Fixed |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ProQuad | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.5 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3687 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150715 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | Test Case Fixed |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | Test Case Fixed |
| RXR.1.2 | Text | Subcutaneous | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Subcutaneous | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | Test Case Fixed |
| RXR.2.2 | Text | Left Deltoid | Test Case Fixed |
| RXR.2.3 | Name of Coding System | HL70163 | Test Case Fixed |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20140819 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | Test Case Fixed |
| OBX.3.2 | Text | Reaction | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | |
| MSH.2 | Encoding Characters | ^~\& | |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | Test EHR Application | |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | X68 | |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | ||
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | NIST Test Iz Reg | |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 20120701082240-0500 | |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | VXU | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | VXU_V04 | |
| MSH.10 | Message Control ID | NIST-IZ-001.02 | |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | P | |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | |
| MSH.15 | Accept Acknowledgment Type | ER | |
| MSH.16 | Application Acknowledgment Type | AL | |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z22 | |
| MSH.21.2 | Namespace ID | CDCPHINVS | |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID.1 | Set ID - PID | 1 | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 123456 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYEHR | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | MR | |
| PID.3 | Patient Identifier List | ||
| PID.3.1 | ID Number | 987633 | |
| PID.3.3 | Check Digit Scheme | ||
| PID.3.4 | Assigning Authority | ||
| PID.3.4.1 | Namespace ID | MYIIS | |
| PID.3.4.2 | Universal ID | ||
| PID.3.4.3 | Universal ID Type | ||
| PID.3.5 | Identifier Type Code | SR | |
| PID.5 | Patient Name | ||
| PID.5.1 | Family Name | ||
| PID.5.1.1 | Surname | Gonzales | Test Case Fixed |
| PID.5.1.2 | Own Surname Prefix | ||
| PID.5.1.3 | Own Surname | ||
| PID.5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.5.1.5 | Surname From Partner/Spouse | ||
| PID.5.2 | Given Name | Juana | Test Case Fixed |
| PID.5.3 | Second and Further Given Names or Initials Thereof | Mariana | Test Case Fixed |
| PID.5.7 | Name Type Code | L | Test Case Fixed |
| PID.6 | Mother's Maiden Name | ||
| PID.6.1 | Family Name | ||
| PID.6.1.1 | Surname | Acosta | Test Case Fixed |
| PID.6.1.2 | Own Surname Prefix | ||
| PID.6.1.3 | Own Surname | ||
| PID.6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID.6.1.5 | Surname From Partner/Spouse | ||
| PID.6.7 | Name Type Code | M | Test Case Fixed |
| PID.7 | Date/Time of Birth | ||
| PID.7.1 | Time | 200912231105 | Test Case Fixed |
| PID.8 | Administrative Sex | F | Test Case Fixed |
| PID.10 | Race | ||
| PID.10.1 | Identifier | 2131-1 | Test Case Fixed |
| PID.10.2 | Text | Other Race | Test Case Fixed |
| PID.10.3 | Name of Coding System | HL70005 | Test Case Fixed |
| PID.10.5 | Alternate Text | ||
| PID.10.6 | Name of Alternate Coding System | ||
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | Test Case Fixed |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06903 | Test Case Fixed |
| PID.11.6 | Country | USA | Test Case Fixed |
| PID.11.7 | Address Type | L | Test Case Fixed |
| PID.11 | Patient Address | ||
| PID.11.1 | Street Address | ||
| PID.11.1.1 | Street or Mailing Address | 325 Shorline Drive | |
| PID.11.1.2 | Street Name | ||
| PID.11.1.3 | Dwelling Number | ||
| PID.11.2 | Other Designation | ||
| PID.11.3 | City | Stamford | |
| PID.11.4 | State or Province | CT | Test Case Fixed |
| PID.11.5 | Zip or Postal Code | 06901 | |
| PID.11.6 | Country | ||
| PID.11.7 | Address Type | BDL | Test Case Fixed |
| PID.13 | Phone Number - Home | ||
| PID.13.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| PID.13.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| PID.13.4 | Email Address | ||
| PID.13.6 | Area/City Code | 203 | Test Case Fixed |
| PID.13.7 | Local Number | 5551212 | Test Case Fixed |
| PID.22 | Ethnic Group | ||
| PID.22.1 | Identifier | 2135-2 | Test Case Fixed |
| PID.22.2 | Text | Hispanic or Latino | Test Case Fixed |
| PID.22.3 | Name of Coding System | CDCREC | Test Case Fixed |
| PID.22.5 | Alternate Text | ||
| PID.22.6 | Name of Alternate Coding System | ||
| PID.24 | Multiple Birth Indicator | ||
| PID.25 | Birth Order | ||
| PID.29 | Patient Death Date and Time | ||
| PID.29.1 | Time | ||
| PID.30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1.11 | Publicity Code | ||
| PD1.11.1 | Identifier | 02 | |
| PD1.11.2 | Text | Reminder/Recall - any method | |
| PD1.11.3 | Name of Coding System | HL70215 | |
| PD1.11.5 | Alternate Text | ||
| PD1.11.6 | Name of Alternate Coding System | ||
| PD1.12 | Protection Indicator | ||
| PD1.13 | Protection Indicator Effective Date | ||
| PD1.16 | Immunization Registry Status | A | |
| PD1.17 | Immunization Registry Status Effective Date | 20120701 | |
| PD1.18 | Publicity Code Effective Date | 20120701 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1.1 | Set ID - NK1 | 1 | |
| NK1.2 | Name | ||
| NK1.2.1 | Family Name | ||
| NK1.2.1.1 | Surname | Gonzales | |
| NK1.2.1.2 | Own Surname Prefix | ||
| NK1.2.1.3 | Own Surname | ||
| NK1.2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1.2.1.5 | Surname From Partner/Spouse | ||
| NK1.2.2 | Given Name | Joanna | Test Case Fixed |
| NK1.2.3 | Second and Further Given Names or Initials Thereof | Merida | Test Case Fixed |
| NK1.2.7 | Name Type Code | L | Test Case Fixed |
| NK1.3 | Relationship | ||
| NK1.3.1 | Identifier | GRP | Test Case Fixed |
| NK1.3.2 | Text | Grandparent | Test Case Fixed |
| NK1.3.3 | Name of Coding System | HL70063 | Test Case Fixed |
| NK1.3.5 | Alternate Text | ||
| NK1.3.6 | Name of Alternate Coding System | ||
| NK1.4 | Address | ||
| NK1.4.1 | Street Address | ||
| NK1.4.1.1 | Street or Mailing Address | 4345 Standish Way | Test Case Fixed |
| NK1.4.1.2 | Street Name | ||
| NK1.4.1.3 | Dwelling Number | ||
| NK1.4.2 | Other Designation | ||
| NK1.4.3 | City | Stamford | Test Case Fixed |
| NK1.4.4 | State or Province | CT | Test Case Fixed |
| NK1.4.5 | Zip or Postal Code | 06901 | Test Case Fixed |
| NK1.4.6 | Country | ||
| NK1.4.7 | Address Type | L | Test Case Fixed |
| NK1.5 | Phone Number | ||
| NK1.5.2 | Telecommunication Use Code | PRN | Test Case Fixed |
| NK1.5.3 | Telecommunication Equipment Type | PH | Test Case Fixed |
| NK1.5.4 | Email Address | ||
| NK1.5.6 | Area/City Code | 203 | Test Case Fixed |
| NK1.5.7 | Local Number | 5551212 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Sirtis | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Lisa | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Carter | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Jane | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SH | |
| ORC.17.2 | Text | Shoreline Hospital | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Rodriguez | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | J | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 9999 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Ricci | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Gina | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Herrera | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Carlos | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Martinez | |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | J | |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | F | |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | OP | |
| ORC.17.2 | Text | Oceanview Pediatrics | |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC.1 | Order Control | RE | |
| ORC.2 | Placer Order Number | ||
| ORC.2.1 | Entity Identifier | ||
| ORC.2.2 | Namespace ID | ||
| ORC.2.3 | Universal ID | ||
| ORC.2.4 | Universal ID Type | ||
| ORC.3 | Filler Order Number | ||
| ORC.3.1 | Entity Identifier | 197027 | |
| ORC.3.2 | Namespace ID | DCS | |
| ORC.3.3 | Universal ID | ||
| ORC.3.4 | Universal ID Type | ||
| ORC.10 | Entered By | ||
| ORC.10.1 | ID Number | ||
| ORC.10.2 | Family Name | ||
| ORC.10.2.1 | Surname | Molina | Test Case Fixed |
| ORC.10.2.2 | Own Surname Prefix | ||
| ORC.10.2.3 | Own Surname | ||
| ORC.10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.10.2.5 | Surname From Partner/Spouse | ||
| ORC.10.3 | Given Name | Sandra | Test Case Fixed |
| ORC.10.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.10.9 | Assigning Authority | ||
| ORC.10.9.1 | Namespace ID | ||
| ORC.10.9.2 | Universal ID | ||
| ORC.10.9.3 | Universal ID Type | ||
| ORC.10.10 | Name Type Code | ||
| ORC.10.12 | Check Digit Scheme | ||
| ORC.10.13 | Identifier Type Code | ||
| ORC.12 | Ordering Provider | ||
| ORC.12.1 | ID Number | ||
| ORC.12.2 | Family Name | ||
| ORC.12.2.1 | Surname | Smith | Test Case Fixed |
| ORC.12.2.2 | Own Surname Prefix | ||
| ORC.12.2.3 | Own Surname | ||
| ORC.12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC.12.2.5 | Surname From Partner/Spouse | ||
| ORC.12.3 | Given Name | Frank | Test Case Fixed |
| ORC.12.4 | Second and Further Given Names or Initials Thereof | ||
| ORC.12.9 | Assigning Authority | ||
| ORC.12.9.1 | Namespace ID | ||
| ORC.12.9.2 | Universal ID | ||
| ORC.12.9.3 | Universal ID Type | ||
| ORC.12.10 | Name Type Code | L | Test Case Fixed |
| ORC.12.12 | Check Digit Scheme | ||
| ORC.12.13 | Identifier Type Code | ||
| ORC.17 | Entering Organization | ||
| ORC.17.1 | Identifier | SP | |
| ORC.17.2 | Text | Shoreline Pediatrics | Test Case Fixed |
| ORC.17.3 | Name of Coding System | HL70362 | |
| ORC.17.5 | Alternate Text | ||
| ORC.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20091123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Sirtis | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Lisa | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6332FK33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101214 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100115 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 45 | |
| RXA.5.2 | Text | hepatitis B vaccine, unspecified formulation | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | Historical Immunization | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK1 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101001 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101030 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 08 | |
| RXA.5.2 | Text | hepatitis B vaccine, pediatric or pediatric/adolescent dosage | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ENGERIX-B | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6352FK24 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120831 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 107 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2341 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20111130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS2433 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110904 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS3255 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101201 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D409QS249 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110301 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20140831 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 106 | |
| RXA.5.2 | Text | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | DAPTACEL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D643QS8243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140901 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M54K9245 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100324 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M55K3342 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101030 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M75K4566 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100523 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 49 | |
| RXA.5.2 | Text | Haemophilus influenzae type b vaccine, PRP-OMP conjugate | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PedvaxHIB | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7M53K5534 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV2431 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101004 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D333PV4344 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100323 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | IPOL | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 02 | |
| RXA.9.2 | Text | Historical information - from other provider | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Casera | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Linda | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D335PV9644 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110222 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi Pasteur Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150519 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 10 | |
| RXA.5.2 | Text | poliovirus vaccine, inactivated | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ||
| RXA.5.6 | Name of Alternate Coding System | ||
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | ||
| RXA.9.2 | Text | ||
| RXA.9.3 | Name of Coding System | ||
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | ||
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | ||
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | ||
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | ||
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | ||
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | ||
| RXA.17.2 | Text | ||
| RXA.17.3 | Name of Coding System | ||
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | 00 | |
| RXA.18.2 | Text | Parental decision | |
| RXA.18.3 | Name of Coding System | NIP002 | |
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | RE | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100121 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P243V3281 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100130 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P343V8321 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100330 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100522 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V2164 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100830 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20110221 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 133 | |
| RXA.5.2 | Text | pneumococcal conjugate vaccine, 13 valent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | PREVNAR 13 | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | P853V58532 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110418 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PFR | |
| RXA.17.2 | Text | Pfizer, Inc | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV533 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100323 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 119 | |
| RXA.5.2 | Text | rotavirus, live, monovalent vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ROTARIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RV932 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20100510 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20100925 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101027 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D8043IN8734 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20110312 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111002 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9334IN9333 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120522 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20131015 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 161 | |
| RXA.5.2 | Text | Influenza, injectable,quadrivalent, preservative free, pediatric | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FLUZONE QUADRIVALENT | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 03 | |
| RXA.9.2 | Text | Historical information - from parents written record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Ricci | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Gina | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3423 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20140701 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune, LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 0.2 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | |
| RXA.9.2 | Text | New immunization record | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 8L4B3521 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150815 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MED | |
| RXA.17.2 | Text | MedImmune,LLC | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121104 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 149 | |
| RXA.5.2 | Text | influenza, live, intranasal, quadrivalent | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | FluMist Quadrivalent | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | D9553IN2243 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120430 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20111123 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT33 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120124 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | SKB | |
| RXA.17.2 | Text | GlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20120523 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 83 | |
| RXA.5.2 | Text | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | HAVRIX | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 6359RT48 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20120911 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | PMC | |
| RXA.17.2 | Text | Sanofi PasteurGlaxoSmithKline Biologicals SA | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20101023 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 01 | |
| RXA.9.2 | Text | historical | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W27V7491 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20101215 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20121122 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | |
| RXA.5.3 | Name of Coding System | CVX | |
| RXA.5.5 | Alternate Text | ProQuad | |
| RXA.5.6 | Name of Alternate Coding System | NDC | |
| RXA.6 | Administered Amount | 999 | |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | ||
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | ||
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 08 | |
| RXA.9.2 | Text | Historical information - from public agency | |
| RXA.9.3 | Name of Coding System | NIP001 | |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Martinez | |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | J | |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3452 | |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20130413 | |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | |
| RXA.17.3 | Name of Coding System | MVX | |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA.1 | Give Sub-ID Counter | 0 | |
| RXA.2 | Administration Sub-ID Counter | 1 | |
| RXA.3 | Date/Time Start of Administration | ||
| RXA.3.1 | Time | 20150715 | |
| RXA.5 | Administered Code | ||
| RXA.5.1 | Identifier | 94 | Test Case Fixed |
| RXA.5.2 | Text | measles, mumps, rubella, and varicella virus vaccine | Test Case Fixed |
| RXA.5.3 | Name of Coding System | CVX | Test Case Fixed |
| RXA.5.5 | Alternate Text | ProQuad | Test Case Fixed |
| RXA.5.6 | Name of Alternate Coding System | NDC | Test Case Fixed |
| RXA.6 | Administered Amount | 0.5 | Test Case Fixed |
| RXA.7 | Administered Units | ||
| RXA.7.1 | Identifier | mL | Test Case Fixed |
| RXA.7.2 | Text | ||
| RXA.7.3 | Name of Coding System | UCUM | Test Case Fixed |
| RXA.7.5 | Alternate Text | ||
| RXA.7.6 | Name of Alternate Coding System | ||
| RXA.9 | Administration Notes | ||
| RXA.9.1 | Identifier | 00 | Test Case Fixed |
| RXA.9.2 | Text | New immunization record | Test Case Fixed |
| RXA.9.3 | Name of Coding System | NIP001 | Test Case Fixed |
| RXA.9.5 | Alternate Text | ||
| RXA.9.6 | Name of Alternate Coding System | ||
| RXA.10 | Administering Provider | ||
| RXA.10.1 | ID Number | ||
| RXA.10.2 | Family Name | ||
| RXA.10.2.1 | Surname | Molina | Test Case Fixed |
| RXA.10.2.2 | Own Surname Prefix | ||
| RXA.10.2.3 | Own Surname | ||
| RXA.10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA.10.2.5 | Surname From Partner/Spouse | ||
| RXA.10.3 | Given Name | Sandra | Test Case Fixed |
| RXA.10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA.10.9 | Assigning Authority | ||
| RXA.10.9.1 | Namespace ID | ||
| RXA.10.9.2 | Universal ID | ||
| RXA.10.9.3 | Universal ID Type | ||
| RXA.10.10 | Name Type Code | ||
| RXA.10.12 | Check Digit Scheme | ||
| RXA.10.13 | Identifier Type Code | ||
| RXA.11 | Administered-at Location | ||
| RXA.11.4 | Facility | ||
| RXA.11.4.1 | Namespace ID | DCS_DC | |
| RXA.11.4.2 | Universal ID | ||
| RXA.11.4.3 | Universal ID Type | ||
| RXA.15 | Substance Lot Number | 7W87V3687 | Test Case Fixed |
| RXA.16 | Substance Expiration Date | ||
| RXA.16.1 | Time | 20150715 | Test Case Fixed |
| RXA.17 | Substance Manufacturer Name | ||
| RXA.17.1 | Identifier | MSD | Test Case Fixed |
| RXA.17.2 | Text | Merck Sharp \T\ Dohme Corp | Test Case Fixed |
| RXA.17.3 | Name of Coding System | MVX | Test Case Fixed |
| RXA.17.5 | Alternate Text | ||
| RXA.17.6 | Name of Alternate Coding System | ||
| RXA.18 | Substance/Treatment Refusal Reason | ||
| RXA.18.1 | Identifier | ||
| RXA.18.2 | Text | ||
| RXA.18.3 | Name of Coding System | ||
| RXA.18.5 | Alternate Text | ||
| RXA.18.6 | Name of Alternate Coding System | ||
| RXA.20 | Completion Status | CP | Test Case Fixed |
| RXA.21 | Action Code - RXA | A |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | SC | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LT | |
| RXR.2.2 | Text | Left Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RT | |
| RXR.2.2 | Text | Right Thigh | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38284 | |
| RXR.1.2 | Text | Nasal | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Nasal | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | BN | |
| RXR.2.2 | Text | Bilateral Nares | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | RD | |
| RXR.2.2 | Text | Right Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C28161 | |
| RXR.1.2 | Text | IM | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | IM | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | |
| RXR.1.2 | Text | Subcutaneous | |
| RXR.1.3 | Name of Coding System | NCIT | |
| RXR.1.5 | Alternate Text | Subcutaneous | |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | |
| RXR.2.2 | Text | Left Deltoid | |
| RXR.2.3 | Name of Coding System | HL70163 | |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR.1 | Route | ||
| RXR.1.1 | Identifier | C38299 | Test Case Fixed |
| RXR.1.2 | Text | Subcutaneous | Test Case Fixed |
| RXR.1.3 | Name of Coding System | NCIT | Test Case Fixed |
| RXR.1.5 | Alternate Text | Subcutaneous | Test Case Fixed |
| RXR.1.6 | Name of Alternate Coding System | HL70162 | Test Case Fixed |
| RXR.2 | Administration Site | ||
| RXR.2.1 | Identifier | LD | Test Case Fixed |
| RXR.2.2 | Text | Left Deltoid | Test Case Fixed |
| RXR.2.3 | Name of Coding System | HL70163 | Test Case Fixed |
| RXR.2.5 | Alternate Text | ||
| RXR.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | |
| OBX.3.2 | Text | Reaction | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20100522 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20140819 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 2 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29768-9 | |
| OBX.3.2 | Text | VIS Publication Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20100521 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 3 | |
| OBX.2 | Value Type | TS | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 29769-7 | |
| OBX.3.2 | Text | VIS Presentation Date | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.5.1 | Time | 20150715 | |
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 1 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 64994-7 | |
| OBX.3.2 | Text | vaccine fund pgm elig cat | |
| OBX.3.3 | Name of Coding System | LN | |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX.1 | Set ID - OBX | 21 | |
| OBX.2 | Value Type | CE | |
| OBX.3 | Observation Identifier | ||
| OBX.3.1 | Identifier | 31044-1 | Test Case Fixed |
| OBX.3.2 | Text | Reaction | Test Case Fixed |
| OBX.3.3 | Name of Coding System | LN | Test Case Fixed |
| OBX.3.5 | Alternate Text | ||
| OBX.3.6 | Name of Alternate Coding System | ||
| OBX.4 | Observation Sub-ID | 1 | |
| OBX.5 | Observation Value | ||
| OBX.6 | Units | ||
| OBX.6.1 | Identifier | ||
| OBX.6.2 | Text | ||
| OBX.6.3 | Name of Coding System | ||
| OBX.6.5 | Alternate Text | ||
| OBX.6.6 | Name of Alternate Coding System | ||
| OBX.11 | Observation Result Status | F | |
| OBX.14 | Date/Time of the Observation | ||
| OBX.14.1 | Time | 20150715 | |
| OBX.17 | Observation Method | ||
| OBX.17.1 | Identifier | ||
| OBX.17.2 | Text | ||
| OBX.17.3 | Name of Coding System | ||
| OBX.17.5 | Alternate Text | ||
| OBX.17.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Mother's Maiden Name | Maria Acosta |
| ID Number | 123456 987633 |
| Date/Time of Birth | 12/23/2009 |
| Administrative Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT 06903 USA |
| Patient Address 1 | 325 Shorline Drive Stamford CT 06901 |
| Local Number | (203)555-1212 |
| Race | Other Race |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Joanna Merida Gonzales |
| Relationship | Grandparent |
| Address | 4345 Standish Way Stamford CT 06901 |
| Phone Number | (203)555-1212 |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 11/23/2009 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Lisa Sirtis |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, unspecified formulation |
| Date/Time Start of Administration | 01/15/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Immunization |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6352FK1 |
| Substance Expiration Date | 10/01/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 10/30/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6352FK24 |
| Substance Expiration Date | 08/31/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2341 |
| Substance Expiration Date | 11/30/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2433 |
| Substance Expiration Date | 09/04/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS3255 |
| Substance Expiration Date | 12/01/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Reaction | fever of >40.5C (105F) within 48 hours of dose |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS249 |
| Substance Expiration Date | 03/01/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 08/31/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D643QS8243 |
| Substance Expiration Date | 09/01/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M54K9245 |
| Substance Expiration Date | 03/24/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M55K3342 |
| Substance Expiration Date | 10/30/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M75K4566 |
| Substance Expiration Date | 05/23/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M53K5534 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV2431 |
| Substance Expiration Date | 10/04/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV4344 |
| Substance Expiration Date | 03/23/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D335PV9644 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 05/19/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/21/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P243V3281 |
| Substance Expiration Date | 01/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P343V8321 |
| Substance Expiration Date | 03/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V2164 |
| Substance Expiration Date | 08/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V58532 |
| Substance Expiration Date | 04/18/2011 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV533 |
| Substance Expiration Date | 02/15/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV932 |
| Substance Expiration Date | 05/10/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 09/25/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/27/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/02/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9334IN9333 |
| Substance Expiration Date | 05/22/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/15/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from parents written record |
| Administering Provider | Gina Ricci |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 07/01/2014 |
| Substance Manufacturer Name | MedImmune, LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Gina Ricci |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.2 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 8L4B3521 |
| Substance Expiration Date | 08/15/2015 |
| Substance Manufacturer Name | MedImmune,LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 08/19/2014 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 11/04/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9553IN2243 |
| Substance Expiration Date | 04/30/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 11/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT33 |
| Substance Expiration Date | 01/24/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 05/23/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT48 |
| Substance Expiration Date | 09/11/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 10/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | historical |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W27V7491 |
| Substance Expiration Date | 12/15/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W87V3452 |
| Substance Expiration Date | 04/13/2013 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 7W87V3687 |
| Substance Expiration Date | 07/15/2015 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 05/21/2010 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| vaccine fund pgm elig cat | Not VFC elig |
| Reaction | persistent, inconsolable crying lasting > 3 hours within 48 hours of dose |
| Element | Data |
|---|---|
| Patient Name | Juana Mariana Gonzales |
| Mother's Maiden Name | Maria Acosta |
| ID Number | 123456 987633 |
| Date/Time of Birth | 12/23/2009 |
| Administrative Sex | Female |
| Patient Address | 4345 Standish Way Stamford CT 06903 USA |
| Patient Address 1 | 325 Shorline Drive Stamford CT 06901 |
| Local Number | (203)555-1212 |
| Race | Other Race |
| Ethnic Group | Hispanic or Latino |
| Birth Order |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 07/01/2012 |
| Publicity Code | Reminder/Recall - any method |
| Publicity Code Effective Date | 07/01/2012 |
| Protection Indicator | |
| Protection Indicator Effective Date |
| Element | Data |
|---|---|
| Name | Joanna Merida Gonzales |
| Relationship | Grandparent |
| Address | 4345 Standish Way Stamford CT 06901 |
| Phone Number | (203)555-1212 |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 11/23/2009 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | Lisa Sirtis |
| Substance Lot Number | 6332FK33 |
| Substance Expiration Date | 12/14/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Shoreline Hospital |
| Entered By | Lisa Sirtis |
| Ordered By | Jane Carter |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, unspecified formulation |
| Date/Time Start of Administration | 01/15/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Immunization |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 6352FK1 |
| Substance Expiration Date | 10/01/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | hepatitis B vaccine, pediatric or pediatric/adolescent dosage |
| Date/Time Start of Administration | 10/30/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6352FK24 |
| Substance Expiration Date | 08/31/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2341 |
| Substance Expiration Date | 11/30/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS2433 |
| Substance Expiration Date | 09/04/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS3255 |
| Substance Expiration Date | 12/01/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Reaction | fever of >40.5C (105F) within 48 hours of dose |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D409QS249 |
| Substance Expiration Date | 03/01/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis |
| Date/Time Start of Administration | 08/31/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D643QS8243 |
| Substance Expiration Date | 09/01/2014 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M54K9245 |
| Substance Expiration Date | 03/24/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M55K3342 |
| Substance Expiration Date | 10/30/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M75K4566 |
| Substance Expiration Date | 05/23/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Haemophilus influenzae type b vaccine, PRP-OMP conjugate |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7M53K5534 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV2431 |
| Substance Expiration Date | 10/04/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D333PV4344 |
| Substance Expiration Date | 03/23/2010 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from other provider |
| Administering Provider | Linda Casera |
| Substance Lot Number | D335PV9644 |
| Substance Expiration Date | 02/22/2011 |
| Substance Manufacturer Name | Sanofi Pasteur Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | J Rodriguez |
| Element | Data |
|---|---|
| Administered Code | poliovirus vaccine, inactivated |
| Date/Time Start of Administration | 05/19/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 01/21/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P243V3281 |
| Substance Expiration Date | 01/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P343V8321 |
| Substance Expiration Date | 03/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | SC |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 05/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V2164 |
| Substance Expiration Date | 08/30/2010 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | pneumococcal conjugate vaccine, 13 valent |
| Date/Time Start of Administration | 02/21/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | P853V58532 |
| Substance Expiration Date | 04/18/2011 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 01/22/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV533 |
| Substance Expiration Date | 02/15/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | rotavirus, live, monovalent vaccine |
| Date/Time Start of Administration | 03/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RV932 |
| Substance Expiration Date | 05/10/2010 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 09/25/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/27/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D8043IN8734 |
| Substance Expiration Date | 03/12/2011 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Thigh |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/02/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9334IN9333 |
| Substance Expiration Date | 05/22/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | Influenza, injectable,quadrivalent, preservative free, pediatric |
| Date/Time Start of Administration | 10/15/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from parents written record |
| Administering Provider | Gina Ricci |
| Substance Lot Number | 8L4B3423 |
| Substance Expiration Date | 07/01/2014 |
| Substance Manufacturer Name | MedImmune, LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Gina Ricci |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.2 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 8L4B3521 |
| Substance Expiration Date | 08/15/2015 |
| Substance Manufacturer Name | MedImmune,LLC |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Nasal |
| Administration Site | Bilateral Nares |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 08/19/2014 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| Element | Data |
|---|---|
| Administered Code | influenza, live, intranasal, quadrivalent |
| Date/Time Start of Administration | 11/04/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | D9553IN2243 |
| Substance Expiration Date | 04/30/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 11/23/2011 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT33 |
| Substance Expiration Date | 01/24/2012 |
| Substance Manufacturer Name | GlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Right Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | Carlos Herrera |
| Element | Data |
|---|---|
| Administered Code | hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule |
| Date/Time Start of Administration | 05/23/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 6359RT48 |
| Substance Expiration Date | 09/11/2012 |
| Substance Manufacturer Name | Sanofi PasteurGlaxoSmithKline Biologicals SA |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | IM |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 10/23/2010 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | historical |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W27V7491 |
| Substance Expiration Date | 12/15/2010 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 11/22/2012 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical information - from public agency |
| Administering Provider | J Martinez |
| Substance Lot Number | 7W87V3452 |
| Substance Expiration Date | 04/13/2013 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Oceanview Pediatrics |
| Entered By | J Martinez |
| Ordered By | F Smith |
| Element | Data |
|---|---|
| Administered Code | measles, mumps, rubella, and varicella virus vaccine |
| Date/Time Start of Administration | 07/15/2015 |
| Administered Amount | 0.5 |
| Administered Units | |
| Administration Notes | New immunization record |
| Administering Provider | Sandra Molina |
| Substance Lot Number | 7W87V3687 |
| Substance Expiration Date | 07/15/2015 |
| Substance Manufacturer Name | Merck Sharp \T\ Dohme Corp |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Deltoid |
| Entering Organization | Shoreline Pediatrics |
| Entered By | Sandra Molina |
| Ordered By | Frank Smith |
| Element | Data |
|---|---|
| VIS Publication Date | 05/21/2010 |
| VIS Presentation Date | 07/15/2015 |
| vaccine fund pgm elig cat | Not VFC elig |
| vaccine fund pgm elig cat | Not VFC elig |
| Reaction | persistent, inconsolable crying lasting > 3 hours within 48 hours of dose |
| No Description |
| No Comments |
| No PreCondition |
| No PostCondition |
| No Test Objectives |
| No evaluation criteria |
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Profile Fixed |
| MSH.2 | Encoding Characters | ^~\& | Profile Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | NIST APP | Test Case Fixed |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | NIST Test Iz Reg | Test Case Fixed |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | Test EHR Application | Test Case Fixed |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | X68 | Test Case Fixed |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 200906040000-0500 | System Generated |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | NIST-IZ-ACK-001.02 | Test Case Fixed |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | T | Test Case Fixed |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | Profile Fixed |
| MSH.15 | Accept Acknowledgment Type | NE | Profile Fixed |
| MSH.16 | Application Acknowledgment Type | NE | Profile Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | Profile Fixed |
| MSH.21.2 | Namespace ID | CDCPHINVS | Profile Fixed |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | Test Case Fixed |
| MSA.2 | Message Control ID | NIST-IZ-001.02 | Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH.1 | Field Separator | | | Profile Fixed |
| MSH.2 | Encoding Characters | ^~\& | Profile Fixed |
| MSH.3 | Sending Application | ||
| MSH.3.1 | Namespace ID | NIST APP | Test Case Fixed |
| MSH.3.2 | Universal ID | ||
| MSH.3.3 | Universal ID Type | ||
| MSH.4 | Sending Facility | ||
| MSH.4.1 | Namespace ID | NIST Test Iz Reg | Test Case Fixed |
| MSH.4.2 | Universal ID | ||
| MSH.4.3 | Universal ID Type | ||
| MSH.5 | Receiving Application | ||
| MSH.5.1 | Namespace ID | Test EHR Application | Test Case Fixed |
| MSH.5.2 | Universal ID | ||
| MSH.5.3 | Universal ID Type | ||
| MSH.6 | Receiving Facility | ||
| MSH.6.1 | Namespace ID | X68 | Test Case Fixed |
| MSH.6.2 | Universal ID | ||
| MSH.6.3 | Universal ID Type | ||
| MSH.7 | Date/Time Of Message | ||
| MSH.7.1 | Time | 200906040000-0500 | System Generated |
| MSH.9 | Message Type | ||
| MSH.9.1 | Message Code | ACK | |
| MSH.9.2 | Trigger Event | V04 | |
| MSH.9.3 | Message Structure | ACK | |
| MSH.10 | Message Control ID | NIST-IZ-ACK-001.02 | Test Case Fixed |
| MSH.11 | Processing ID | ||
| MSH.11.1 | Processing ID | T | Test Case Fixed |
| MSH.12 | Version ID | ||
| MSH.12.1 | Version ID | 2.5.1 | Profile Fixed |
| MSH.15 | Accept Acknowledgment Type | NE | Profile Fixed |
| MSH.16 | Application Acknowledgment Type | NE | Profile Fixed |
| MSH.21 | Message Profile Identifier | ||
| MSH.21.1 | Entity Identifier | Z23 | Profile Fixed |
| MSH.21.2 | Namespace ID | CDCPHINVS | Profile Fixed |
| MSH.21.3 | Universal ID | ||
| MSH.21.4 | Universal ID Type | ||
| MSH.22 | Sending Responsible Organization | ||
| MSH.22.1 | Organization Name | ||
| MSH.22.6 | Assigning Authority | ||
| MSH.22.6.1 | Namespace ID | ||
| MSH.22.6.2 | Universal ID | ||
| MSH.22.6.3 | Universal ID Type | ||
| MSH.22.7 | Identifier Type Code | ||
| MSH.22.10 | Organization Identifier | ||
| MSH.23 | Receiving Responsible Organization | ||
| MSH.23.1 | Organization Name | ||
| MSH.23.6 | Assigning Authority | ||
| MSH.23.6.1 | Namespace ID | ||
| MSH.23.6.2 | Universal ID | ||
| MSH.23.6.3 | Universal ID Type | ||
| MSH.23.7 | Identifier Type Code | ||
| MSH.23.10 | Organization Identifier |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA.1 | Acknowledgment Code | AA | Test Case Fixed |
| MSA.2 | Message Control ID | NIST-IZ-001.02 | Test Case Fixed |